The impact of early Speech Pathology led dysphagia assessment in emergency and medical settings
Lucy Lyons1, Jackie Moon1, Tanya Hirst1, Anne Maree Buttner11Mater Hospital Brisbane, South Brisbane, Queensland, Australia
Abstract
Dysphagia in older adults is a frequent and serious condition that is under recognised and under referred to Speech Pathology (SP) from Emergency Departments (ED). Dysphagia impairs swallowing efficiency and safety with increased risk of aspiration pneumonia, mortality, malnutrition, frequent hospital admissions with prolonged Length of Stay (LOS) and increased healthcare costs. Research demonstrates that up to 30% of adults admitted to hospital emergency Departments display signs of dysphagia.
At our acute metropolitan hospital in Brisbane, data suggested that dysphagia was not being identified early enough in patient admissions. For example, only 2 patients had been referred to SP through ED during a 3 month period. Chart audits of patients at risk of dysphagia admitted to medical wards revealed nurse-led dysphagia screening was either absent, inconsistent or inaccurate, resulting in few referrals to SP. There were over 30 clinical incidents relating to the lack of dysphagia screening and subsequent mismanagement of dysphagia reported over a 20 month period. Incidents related to: patients not receiving oral medication, prolonged periods of malnutrition and dehydration, aspiration pneumonia, lung abscess, respiratory failure, asphyxiation and death.
To respond to these issues, the Speech Pathology team implemented a 6 month trial in ED to screen for dysphagia using a validated tool. Results were consistent with the literature with just over 30% of patients identified as having dysphagia. The main populations at risk were those over 65 years of age who presented with: (1) fall; (2) respiratory infection/COPD; (3) delirium; (4) back pain and (5) dizziness/syncope. There were positive impacts on length of stay, and medical and nursing staff reported that this model of care improved risk assessment and discharge planning.
This project supported dysphagia screening in ED before patients who are at high risk of dysphagia are dispersed throughout the hospital.
Biography
Tanya Hirst is a Speech Pathologist with 16 years of clinical experience working in emergency, medical and critical care settings in both public and private hospital across Queensland. She has a special interest in diagnosis and management of complex dysphagia.
Lucy Lyons is a Speech Pathologist with 15 years of clinical experience working in public and private acute adult hospital settings across Queensland. She has been a part of and witnessed many changes in health care, and she is passionate about finding innovative solutions to the questions and challenges that impact the delivery of healthcare today.